In looking for an idea for the blog, I came across this site from Mayo Clinic: http://www.mayoclinic.org/cardionews-rst/.  Check it out!

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Yes, there are still new programs being developed in today’s market. The key driving forces for new program development are community demand and potential cardiovascular revenue. If I were to make one suggestion for any program, in addition to critical planning that needs to be done, the key factor that must be addressed is QUALITY! Case selection is critical in the first year. I always tell my clients to be sure that cases are carefully selected to ensure good outcomes and no mortalities. Many programs worry that there is not enough volume and begin to take cases that  should be done after the  staff has gained more experience. This is not to say that anyone is incompetent, just cautious. We want your program to be a success.

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For a medical surgical hospital, cardiac and vascular continue to dominate discharges. Even in programs that I work with that do not have invasive heart and vascular procedures, cardiovascular accounts for 25% to 30% of discharges.

When reviewing the Modern Healthcare Supplement “By The Numbers”, there are six cardiovascular DRGs in the top twenty. There is only one cardiovascualr procedural code - PCI. The groupings are:

• 30% Cardiovascular:  127 (Heart Failure); 143 (Chest Pain); (558) PCI; 138 (Conduction Disorders); 121 (MI); 14 (Stroke)
• 20% Respiratory:  89 (Pneumonia); 88 (COPD); 79 (Respiratory Infection); 475 (Ventilator)
• 15% GI:  182 (Gastroenteritis); 174 (Hemorrhage); 296 (Nutritional Disorders)
• 10% Renal:  320 (Kidney and Urinary Infections); 316 (Renal failure)
• 10% Infection:  277 (Cellulitis); 416 (Septicemia)
• 10% Ortho/Rehab:  544 (Joint Replacement); 462 (Rehab)
• 5% Psychiatric:  430 (Psychosis)

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As part of GWTG, the American Heart Association has established a STEMI program. There is a seminar on Tuesday, May 5th (2 p.m. CDT). For more information, go to: http://www.informz.net/heart/archives/archive_761860.html

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Until there is a mandate on the electronic health records (EHR), it will not happen. Only 1.5% of nonfederal hospitals have a comprehensive program; less than 10% have basic programs. I picture a system that is similar to the VA’s and Medicare billing (both well coordinated) with various vendors.

It does boggle the mind when you realize what is involved, and just thinking about all the various components that have to be coordinated to make it work. I think about the patients and the expectations . I know how many times a wrong number for a physician was accidently entered by registration staff.  How do you make it work when there are five different hospital systems in one town - not even thinking about the big picture?

Essential? Yes! Happening tomorrow? Not unless mandated and coordinated.

Data source:  “Still low tech - EHR adoption rates remain low: study by Joseph Conn, in Modern Healthcare, March 30, 2009, page 9.

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Angioplasty without surgery on site continues to expand across the United States with more than 300 program performing services. The road is also expanding beyond STEMI to include elective services, even in Certificate of Need States with excellent outcomes. Thinking of starting a program? Some of the challenges that are faced include:

• Acceptance by the medical staff
• Recruitment of interventional cardiologist and coverage
• Non-physician staffing
• Strategic planning and partnership
• Capital investment

The impact has been positive for all the hospitals that we have worked with and started similar programs across the country, but it is more than just adding a service.

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Posted By Carolyn Weaver, Executive Consultant

As I have said many times, cardiovascular revenue should be 25% to 50% of the hospital’s bottom line. But how do you really know if you are capturing all of the revenues? Many hospitals tell me that they check charts against the charges, but I have not found too many hospitals that have a specific team that tracks patients from registration through payment. It is typically done in silos with finance looking at the back side and invasive lab or surgery staff looking at the charges. Only when a large discrepancy arises, does the issue get attention.

Recommendations for managing this better are:

• Develop a dedicated cardiovascular revenue review team.
• Track and review inpatient and outpatient services from a financial perspective (to be performed by the team). In a large cardiovascular program, it should be a percentage; in a small program every case, particularly every invasive case, should be reviewed.
• Ensure that benchmarking is developed by program and types of invasive cases.
• Educate the members of the team as well as clinical staff.
• Give kudos as things change.

Would you like some more information and a case example? See http://www.healthmgttech.com/features/2009_april/0409_advantage.aspx

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Posted By Carolyn Weaver, Executive Consultant

How can you jumpstart a mature cardiovascular program? Plan,  plan, and plan! And, of course, re-energize the stakeholders. We have had several calls in the last couple of weeks regarding this topic, and each of the programs is looking to schedule a planning retreat and update their business plan!

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